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VANCOUVER, B.C. -- It's generally a mistake to write a prescription during a refugee's first visit for symptoms of posttraumatic stress disorder; state the diagnosis too soon, and you've already got two strikes against you, Dr. Wahan Wanis said at a meeting on PTSD sponsored by Vancouver General Hospital.

Dr. Wanis urged colleagues not to "cop out" when faced with cross-cultural patients by trying to refer them to a physician who speaks their language or hails from their culture.

Unless such a referral is easy to carry out, it will only delay treatment for what may be a serious problem. And if your patient does finally hunt down a practitioner who speaks Hmong or Tagalog, it doesn't necessarily mean that he or she will get better care than that which you could offer, said Dr. Wanis, a psychiatrist in private practice in Vancouver who speaks six languages and teaches at the University of British Columbia.

"Just speaking a language doesn't make you an expert on a culture," he said.

Moreover, not every symptom suffered by refugees is attributable to culture.

Psychiatrists who tread carefully, respect patients and their families, and exhibit inquisitiveness and openness with regard to cultural differences can often help traumatized patients from cultures other than their own.

Dr. Wanis offered a few ground rules:

* Put away your prescription pad at first. Most cross-cultural patients have some sense, largely from television, that North American doctors, especially psychiatrists, sit in "posh offices and dispense Valium." Building trust, listening, and speaking with family members for several visits before mentioning medication probably will foster compliance. People from many cultures, particularly Latin American cultures, have a profound fear of addiction, so all medications should be carefully explained.

* Slow down and be patient. Physicians often want to make the most of limited time with patients, so they begin a first visit by saying, "Good morning. How are you? What's bothering you? …